Pyuria is the release of a large number of leukocytes, bacteria, necrotic cells of the urinary tract epithelium. It is observed in infectious and inflammatory diseases, purulent processes with damage to the urinary system and genital organs. Found in sepsis. It is detected by the results of a clinical analysis of urine, a three-glass sample. To determine the pathogen, bacterioscopy and urine culture are performed. Ultrasound, X-ray and endoscopic techniques are used to clarify the diagnosis. Treatment includes surgery, antibiotic therapy, physiotherapy.
Pyuria is called massive leukocyturia in combination with bacteriuria, an admixture of dead epithelial cells and secretory proteins. It is confirmed by macroscopic detection of pus in the urine (diffuse opacification with the presence of lumps and flakes) and / or detection of more than 6 leukocytes in the field of view during microscopy of the urine sediment.
A laboratory symptom with a high probability indicates the presence of an acute infectious process or the formation of an abscess. Topical diagnosis is made using a three-cup sample. There are the following types of pyuria:
Sometimes there is a combination of initial and final pyuria, which makes it possible to suspect a prostate abscess that has opened into the urethra.
Pyuria is determined in the following acute inflammatory pathologies and purulent lesions of the kidneys:
The likelihood of developing infectious processes increases with such congenital anomalies as a spongy and horseshoe-shaped kidney. The list of acquired diseases that provoke pyelonephritis and purulent lesions of the kidneys includes urolithiasis, hydronephrosis.
Pyuria in kidney infections
Chronic aseptic pyuria is characteristic of kidney tuberculosis. In the early stages, the pathology is asymptomatic or accompanied by nonspecific manifestations: weakness, fatigue, subfebrile condition, weight loss. The appearance of pus in urine indicates the development of pyelonephritis or pyelitis, often occurs after an episode of hematuria due to the destruction of small vessels in the papillae of the kidneys. Patients are concerned about aching pain, in some cases, renal colic is possible.
Pyuria is observed with inflammation of the urethra, bladder. Acute cystitis is characterized by pain in the lower abdomen and perineum, frequent imperative urges. Urine becomes cloudy or takes on the appearance of "meat slops." Acute urethritis is accompanied by itching, burning, pain during urination, the appearance of purulent or mucopurulent discharge from the external opening of the urethra.
A laboratory symptom is also found in the complicated course of some non-inflammatory diseases of the lower urinary tract. Infected foreign bodies of the bladder are manifested by pyuria, hematuria, urination disorders, pain above the pubis. Due to stagnation of urine in the diverticulum of the bladder, persistent diverticulitis, cystitis with a two-stage urination, terminal pyuria develop. With diverticula of the urethra, incontinence, pollakiuria, and sometimes - the release of drops of pus and hematuria are noted.
In patients with acute prostatitis, pyuria occurs even at the stage of catarrhal inflammation, increases at the follicular and parenchymal stages. Pain, intoxication, urination disorders are detected. A pronounced inflammatory process is accompanied by acute urinary retention, difficulty in defecation, and intense pain. With the development of an abscess of the prostate, severe septic manifestations, sharp throbbing pains are observed.
Acute purulent vesiculitis is characterized by painful spontaneous erections, blood impurities in the semen, dyspareunia, general hyperthermia, weakness, pain in the joints and muscles. Dysuric disorders are often noted. With phimosis, pyuria is caused by the ingress of pus into the urine from the head of the penis, concomitant urethritis. The head is not exposed. Edema, hyperemia of the skin of the preputial sac are found. Urination disorders are possible.
Urogenital fistulas of the vagina have a chronic relapsing course. Urinary incontinence, frequent colpitis, vulvitis, urinary tract infections causing pyuria are detected. With the formation of fistulas due to the melting of the walls of organs against the background of purulent diseases, fever, weakness, weakness, pain in the pubic region and lower abdomen, dysuria, and severe pyuria are noted. In the absence of communications between the vagina and the urinary tract, the admixture of pus in the urine test may be due to violations of the rules for taking material against the background of acute inflammatory pathologies of the genital organs.
Pyuria accompanies the following infectious diseases:
Lupus nephritis, as a rule, develops a year after the formation of the clinical picture of SLE, in almost half of the cases it is asymptomatic. Signs of the underlying disease prevail: serositis, erythema, joint damage. There may be swelling of the face, more pronounced in the morning. The amount of urine excreted decreases. Sometimes there is a reddish hue of urine, due to the admixture of blood. The severity of pyuria varies. In severe cases, arterial hypertension, chronic renal failure are noted.
With septicopyemia, the appearance of pyuria is associated with the formation of purulent foci (carbuncle, abscess) in the kidneys. Against the background of hectic fever, hypotension, adynamia, there is severe pain in the lumbar region. Sepsis of newborns with purulent metastases is characterized by screenings in the meninges, liver, lungs, and kidneys. A clinic of purulent meningitis, abscess of the liver or kidney, abscessing pneumonia can be detected.
In Lemierre's syndrome, pyuria is sterile. Pathology develops against the background of infectious lesions of the oropharynx. The patient's condition worsens, signs of inflammation of the jugular veins join. Arthritis, pneumonia, meningitis are possible. In patients with acute appendicitis, the appearance of pyuria indicates the formation of an abscess and the formation of purulent leakage with the involvement of the urinary organs.
Piuria
Patients with pyuria are examined by urologists. According to indications, consultations of an andrologist, gynecologist, infectious disease specialist are prescribed. The laboratory symptom is confirmed according to the general analysis of urine, two- and three-glass samples. Along with the type of pyuria (initial, terminal or total), the predominance of one or another type of leukocytes in the urine is of clinical significance. A large number of neutrophils is found in nonspecific infections, tuberculosis. The lymphocytic urogram is typical of lupus nephritis. To clarify the nature of the pathology, the following methods are used:
In the absence of a purulent focus, treatment is often carried out on an outpatient basis. The presence of an abscess or the threat of its formation, severe intoxication, the serious condition of the patient are considered as indications for emergency hospitalization. Therapeutic measures in many cases are an addition to operational techniques. The scheme includes:
In case of secondary inflammation, against the background of mechanical obstacles to the outflow of urine, a ureteral catheter-stent is installed or a nephrostomy is applied. With the formation of purulent foci, decapsulation of the kidney is performed. Abscesses of the prostate and kidneys are opened, drained. Patients with tuberculosis undergo cavernotomy or kidney resection. Total purulent or tuberculous lesion of the organ is an indication for nephrectomy. Women with urethro-vaginal fistulas are shown suturing the fistula or vaginoplasty, sometimes - sling urethropexy.